Atypical Oral Presentation of Giant Cell Arteritis With Subsequent Middle Cerebral Artery Involvement

Giant cell arteritis (GCA), also known as Horton’s disease - a large‑vessel vasculitis characterized by granulomatous inflammation of medium and large-sized arteries - is the most common primary systemic vasculitis in adults over the age of 50 . It shows a strong predilection for women, particularly those of Northern European ancestry. The classical presentation includes new‑onset headache, scalp tenderness, jaw claudication and visual disturbance, though the clinical spectrum is heterogeneous and may overlap with other conditions common in older adults . Delayed diagnosis of giant cell arteritis can lead to catastrophic outcomes, including irreversible vision loss and cerebrovascular complications, highlighting the critical importance of early recognition and prompt initiation of high‑dose corticosteroid therapy. Despite improvements in vascular imaging and the introduction of targeted biologic therapies, delays in the diagnosis of giant cell arteritis remain frequent, particularly when initial symptoms are nonspecific or mimic other conditions .We present the case of an elderly woman with coexistent polymyalgia rheumatica and an autoimmune comorbidity who developed bilateral blindness, dysphagia and functional decline due to delayed recognition of GCA, illustrating the severe morbidity that may result when clinical suspicion is not immediately raised.